CMS Bundled Payment Model - CJR

The Centers for Medicare and Medicaid Services (CMS) recently launched its first mandatory bundled payment program. The initial launch was aimed at Total Joint Replacement surgeries because they are the most expensive and common procedures for CMS.

According to CMS, there are more than 1,000,000 TJR surgeries each year. In 2004, aggregate charges (the "national bill") for primary TJR surgeries was $50.5 billion (knees > hips). By 2030, demand for TJR is projected to grow by 174% (hips) and 673% (knees), with the fastest growth among patients under 65 years of age. The average Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.

Comprehensive Care for Joint Replacement (CJR) Reimbursements

At VitalHealth we strive to automate the collection and extraction of outcomes while streamlining the submission of data for quality measures, such as CJR reimbursements. Our solution for Outcome Measurement helps assess patient outcomes, interact with patients, educate patients in their care before, during, and after provider encounters, and allows for questionnaires to be automatically triggered based on alerts. This allows for automated usage of the ICHOM standard sets for Hip & Knee Osteoarthritis.

The CJR model aims to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR).

Under the new CJR program, providers will have to track quality and prove value from the time of surgery to 90 days post discharge. CMS ties each incentive (or penalty) to a quality score based on three measures: